Journal Highlights

Previous studies have shown the prom­ise of mineralocorticoid-receptor an­tagonists in the treatment of chronic or recurrent central serous chorioretinop­athy (CSC). Building on this premise, Sun et al. studied the efficacy of oral spironolactone among patients with acute CSC and found that, compared with observation alone, the treatment was much more effective and resulted in fast absorption of subretinal fluid (SRF).

For this prospective trial, the authors evaluated 30 patients (30 eyes) with acute CSC. The patients were assigned randomly either to the treatment group (spironolactone 40 mg orally, twice daily for 2 months; n = 18) or to the control group (observation alone; n = 12). Main outcome measures were the proportion of eyes with complete resolution of SRF by 2 months and the changes in central macular thickness (CMT), SRF height, best-corrected visual acuity (BCVA), and subfoveal choroidal thickness (SFCT) during the same period.

By 2 months, complete resolution of SRF had occurred in 10 of the 18 treat­ed eyes and in only 1 of the 12 control eyes. Both groups experienced a signif­icant decline in mean CMT and mean SRF height (p < .05), with significant between-group differences apparent at 2 months (p < .05 and p < .05, respec­tively). Mean BCVA improved in both groups by 2 months (p < .05). In the treatment group, mean SFCT decreased significantly, from 502.50 ± 87.38 μm at baseline to 427.44 ± 74.37 μm at 2 months (p < .01), whereas the change from baseline in the control group was not significant. Spironolactone did not produce any adverse effects in this study, perhaps because of the short duration of treatment.

Due to the multifactorial nature of CSC, the mineralocorticoid receptor may play a role in some patients but not others. Findings of this study may help to guide early intervention for acute CSC. In addition, the authors suggested that patients with CSC be given a medication guide to treatment of the disease.